Therapy

Proceed directly to coronary angiography in patients with STEMI who present to experienced centers or can be transferred to a referral center in order to perform primary percutaneous intervention.

Administer a thrombolytic agent as an alternative to primary PCI in suitable candidates with STEMI.

Give anticoagulant therapy with unfractionated heparin, LMWH, or bivalirudin to moderate- and high-risk patients with ACS.

Administer clopidogrel or a newer P2Y12 receptor inhibitor in selected patients with ACS.

Consider administering glycoprotein IIb/IIIa antagonists in addition to aspirin and an anticoagulant as adjunctive therapy in patients undergoing primary percutaneous intervention, or as an alternative to P2Y12 receptor inhibitors.

Administer β-blockers early to patients with suspected ACS unless there are significant contraindications; give a nonselective β-blocker to patients with LV dysfunction after an MI.

Administer nitroglycerin to patients with ACS with ongoing chest discomfort.